Centre for Primary Health Care and Equity

Health Impact AssessmentÉvaluation d’impact sur la santé

Ben Harris-Roxas BSW MPASR PhD

Conjoint Lecturer, University of New South Wales, Sydney

Convenor, HIA Global Working Group, IUHPE

Consultant, ZEST Health Strategies

• Sections

1. Health impact assessment

2. Evolution and forms

3. HIA practice

4. Evaluation of HIA

5. Lessons learned

6. Resources

A note on language

Evaluation vs assessment

Policy vs politics

Health vs health services

• Section 1

• Health impact assessment

A combination of procedures, methods and tools by which a policy, program or project may be assessed for its potential and often unanticipated effects on the health of the population and the distribution of these impacts within the population.

Gothenburg Consensus Paper

European Centre for Health Policy (1999) Gothenburg Consensus Paper on Health Impact Assessment: main concepts and suggested approach, WHO Europe: Brussels (adapted by Mahoney & Morgan).

Key Aspects of HIA

• Prospective (ex ante assessment)

• Combination of methods

• Looks at intended and unintended impacts

• Distribution of impacts

• Evidence-informed recommendations

http://hiaconnect.edu.au/wp-content/uploads/2012/05/Health_Impact_Assessment_A_Practical_Guide.pdf

Distribution of Impacts

• Age

• Gender

• Socioeconomic status

• Location

• Ethnicity and culture

• Existing levels of health and disability

If you implement the

proposal

These will be the impacts

If you make these changes

These will be the gains

Assessment Recommendations

• Section 2• Evolution and forms

1950s 1960s 1970s 1980s 1990s 2000sEnvironmental Disasters

Regulatory Environmental Impact Assessment

Environmental Health

Health EquityHIA

1956 Clean Air Act (UK)

1969 Santa Barbara Channel (USA)

1969 US National Environmental Policy Act (USA)

1978 Love Canal (USA)

1984 Bhopal (India)

1986 Ottawa Charter

1990 Concepts & Principles of Equity in Health

1997 Jakarta Declaration

1999 Gothenburg Consensus Paper on HIA

2008 WHO Commission on the Social Determinants of Health

Social View of Health

1972 Lake Pedder Dam controversy (Australia)

1974 Environmental Protection (Impact of Proposals) Act (Australia)

2005 Health included in IFC Performance Standards

1994 Framework for Environmental and Health IA (Australia)

2007 1st Asia-Pacific HIA Conference (Australia)

1978 Seveso (Italy)

1990 Environmental Protection Act (UK)

1980 The Black Report (UK)

1972 The Indian Wildlife (Protection) Act

1974 Lalonde Report (Canada)

1998 Merseyside Guidelines for HIA

1978 WHO Seminar on Environmental Health Impact Assessment (Greece)

2004 Equity Focused HIA Framework (Australia)

1978 Declaration of Alma Ata

1992 Asian Development Bank HIA Guidelines

1959 Minamata Bay (Japan) 1980 International

Association for Impact Assessment formed

1969 Cuyahoga River Fire (USA)

1962 Silent Spring

2007 HIA’s use included in Thailand’s Constitution

1998 The Solid Facts

1979 Three Mile Island (USA)

2005 Guide to HIA in the Oil and Gas Sector

1986 Chernobyl (Ukraine)

1989 Exxon Valdez Oil Spill (USA)

2009 Montara West Atlas Oil Spill (Australia)

2010Marmot Review

Harris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact Assessment, Environmental Impact Assessment Review, 31(4): 396-403. doi:10.1016/j.eiar.2010.03.003

1999 Erika sinking in Bay of Biscay (France)

2010 Deepwater Horizon (USA)

Mandated

Decision Support

Advocacy

Community ledHarris-Roxas B, Harris E (2011) Differing Forms, Differing Purposes: A Typology of Health Impact Assessment, Environmental Impact Assessment Review, 31(4): 396-403. doi:10.1016/j.eiar.2010.03.003

But this can lead to a lack of consensus about what HIA is

(and what it isn’t)

• Section 3

• HIA Practice

Source: Harris E, Baum F, Harris-Roxas B, Kemp L, Spickett J, Keleher H, HarrisM, Morgan R, Dannenberg A, Sukkumnoed D, Wendel A. The effectiveness of health impact assessments conducted in Australia and New Zealand; Australian Research Council Discovery Project Grants; 2010-2011. [DP1096211]

Source: Winkler M et al. (2013) Untapped potential of health impact assessment, Bull World Health Organ 2013;91:298–305. doi:10.2471/BLT.12.112318

Source: Harris-Roxas B, Harris P. Learning by Doing: The value of case studies of health impact assessment. NSW Public Health Bulletin, 2007:161-163.

Types of Health Impacts

Source: The Rise of HIAs in the United States http://www.pewhealth.org/reports-analysis/data-visualizations/the-rise-of-hias-in-the-united-states-85899464695

Fredsgaard MW, Cave B, Bond A (2009) A Review Package for Health Impact Assessment Reports of Development Projects, Ben Cave Associates: Leeds.

Bhatia R, Farhang L, Heller J, Lee M, Orenstein M, Richardson M and Wernham A. Minimum Elements and Practice Standards for Health Impact Assessment, Version 3. September, 2014.

Rhodus J, Fulk F, Autrey B, O’Shea S, Roth A (2013) A Review of Health Impact Assessments in the U.S.: Current State-of-Science, Best Practices, and Areas for Improvement, Office of Research and Development, National Exposure Research Laboratory, U.S. Environmental Protection Agency: Cincinnati. http://www.epa.gov/research/healthscience/docs/review-hia.pdf

–Essential components for HIA reports

1. A documented and transparent process.

2. A clear statement of the HIA's goals and purpose.

3. A rigorous, documented approach to gathering and assessing evidence.

4. Clear predictions of impacts.

5. Recommendations for enhancement and mitigation.

Harris-Roxas B, Harris P, Wise M, Haigh F, Ng Chok H, Harris E (2013) Health Impact Assessment in Australia in Past Achievement, Current Understanding and Future Progress in Health Impact Assessment (Ed Kemm J), Oxford University Press: Oxford, 223-243.

O'Mullane M, Harris-Roxas B. Health Impact Assessment, Journal of Environmental Assessment Policy and Management, 17(1):11, 2015. doi:10.1142/S1464333215500052

• Section 4

• Evaluation of HIA

Harris-Roxas B, Harris E (2013) The Impact and Effectiveness of Health Impact Assessment: A conceptual framework, Environmental Impact Assessment Review, 42: 51-59. doi:10.1016/j.eiar.2012.09.003

Harris-Roxas B, Haigh F, Travaglia J, Kemp L. Evaluating the impact of equity focused health impact assessment on health service planning: Three case studies, BMC Health Services Research, 14:371. doi:10.1186/1472-6963-14-371 www.biomedcentral.com/1472-6963/14/371

–The factors that influence the impact and effectiveness of HIAs

1. Informing implementation

2. Consolidating understanding of health and health equity

3. Enabling discussion of alternatives

4. Clearer articulation of the values that inform health planning and implementation

5. Time

6. The role of individuals

7. Conceptualisations of the purpose of EFHIA

Harris-Roxas B, Haigh F, Travaglia J, Kemp L. Evaluating the impact of equity focused health impact assessment on health service planning: Three case studies, BMC Health Services Research, 14:371. doi:10.1186/1472-6963-14-371 www.biomedcentral.com/1472-6963/14/371

• Section 5

• Lessons learned

–Common criticisms

• HIA is expensive and time-consuming

• Health is already addressed through planning and policy development

• HIA could create duplication and inefficiencies

• Government response

• “Health impact assessments have been promoted as a means of assessing the health impacts of policies, plans and projects using quantitative, quantitative and participatory techniques. While we think that they may be a useful tool, we believe that they have the potential to be expensive and time-consuming, and we believe that this needs to be taken into account in any further consideration of these.”

• [Senate] Committee view

• …There are already mechanisms in place to ensure that important issues are considered across government when necessary, such as the requirements for inter-departmental consultation in the preparation of cabinet submissions, the requirement for Regulatory Impact Statements in conjunction with the introduction of legislation, and statements of compatibility with human rights.

• Community Affairs References Committee (2013) Australia's domestic response to the World Health Organization's (WHO) Commission on Social Determinants of Health report "Closing the gap within a generation": Submissions

received by the Committee, Australian Senate: Canberra.

• …but there is limited evidence to support these claims empirically.

• For example, I was involved in an equity focused HIA that was completed in 5 days.

• Harris-Roxas B, Harris P, Harris E, Kemp L (2011) A Rapid Equity Focused Health Impact Assessment of a Policy Implementation Plan: An Australian case study and impact evaluation, International Journal for Equity in Health,

10(6). doi:10.1186/1475-9276-10-6

• HIAs can be politicalbecause decision-making is political

• Decisions are made continually, never just once

• Legislation vs capacity building

• is not enough

• We need a more sophisticated way of thinking

Maturity Model Level

5. Optimised

High functioning

4. ManagedSpecific, Measurable Accurate Responsive, Timely (SMART)

3. Defined

Structured approach

2. Repeatable

Processes in place

1. Ad-hoc

Limited system in place

0. Not defined

No level of activity

Level Workforce Tools and resourcesOrganisational development

Governance Partnerships Leadership InvestmentData and technical

systems

Optimised

High functioning service coordination

Sustainable highly skilled workforce

Practical HIA tools are widely used

Sustainable organisational development

High functioning HIA governance and regulatory

mechanisms

Strong HIA partnerships exist

Strong leadership to provide support across

different settingsOngoing investment in HIA

Relevant and intuitive data systems exist to collect consistent information

ManagedSpecific, Measurable Accurate Responsive,

Timely (SMART)

Skilled workforce provide proactive support

HIA resources are commonly used

Strong organisational development exist

Strong HIA governance and regulatory mechanisms

Responsive and adaptable HIA partnerships exist

Recognised leadership Diversified HIA investmentData systems routinely

used to collect information

Defined

A structured approach

Skilled workforceRelevant HIA resources

are customised and adapted

Defined organisational development

Defined HIA governance and regulatory mechanisms

Defined partnership processes

Defined roles and responsibilities

Sustained HIA investmentRelevant data and

technical systems exist

Repeatable

Processes in place

Reactive support providedRelevant HIA resources

existStructured organisational

development

Repeatable HIA governance and regulatory

mechanisms

Structured partnership and governance processes

Identified leaders who may be called upon again

Some investment in HIA Data systems built

Ad-hoc some level of system in place

Ad-hoc workforce identifiedHIA resources identified as

neededSome organisational

developmentAd hoc governance and regulatory mechanisms

Informal processesA form of leadership in

placeIdentified need for investment in HIA

A system in place

Not defined No identified workforce No relevant resources No supportNo governance and

regulatory mechanismsNo processes No support provided No investment

No Systems

 

• Section 6

• HIA Resources

healthimpactassessment.blogspot.com

http://www.inpes.sante.fr/evaluation-impact-en-sante/default.asp

http://www.ccnpps.ca/13/evaluation-d'impact-sur-la-sante.ccnpps

benhr.net/HIAebook

Acknowledgements

Cette présentation est disponible au

www.slideshare.net/benharrisroxas

b.harris-roxas@unsw.edu.au

@ben_hr